Sunday, 09 December 2018

Smartin Benefits PHSP Owner Enrolment Form

Enrolling your Company with Smartin Benefits, makes you the Plan Owner
Smartin Benefits Plan Owner Enrolment Form
  • *
  • *
  • Information: Incorporation Requirement

    Canada Revenue Agency is very clear on this point:
    You must be an Incorporated Company to take advantage of a Smartin Benefits Private Health Services Plan.

  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Information: Effective Plan Date

    By default the Smartin Benefits Plan is effective immediately once the enrollment form is received, but you may choose to specify a date on which the plan starts. You can backdate the plan up to one year.

  • Information: Job Classification

    The Plan Owner may elect to offer this PHSP to Plan Members in varying levels of maximum benefit based on the position or critical importance of the Plan Member within the business. Choose Job Classification(s) for the Employees of your Company. It is required that each Employee within a Job Classification be extended the same annual limits. These Job Classifications can be used when completing the Plan Member Enrolment Forms. This can make future administration easier.

  • *




  • Authorization and Confirmation:

    Note: The act of inputting your name below serves as a general electronic signature and is legally binding.

    I acknowledge (by typing my name below) that the information contained in this application is accurate and true to my knowledge and that I have the authorization to act on the behalf of my organization. I also agree to provide this PHSP to the Plan Members and will pay for all account funding and administration fees as required.

  • *
  • *
  • Referrals:

    We are always interested to know how you found us.  Any names provided below will be kept strictly confidential. We use this information to determine how effective our marketing is and also to thank 3rd parties for referrals.

  • Next Steps:

    Now, type the Captcha characters in the space provided. If you cannot see the characters, click on the image to refresh with a new set of characters.

    Once you completed all the required fields, click on the Submit button. We will contact you as soon as possible.

    Next steps:

    - Pay the Enrollment Fee to activate your Smartin Benefits PHSP.

    - Complete Smartin Benefits PHSP Member Enrolment Form(s) for each of your Employees.